This study will measure the outcomes and effectiveness of Alzheimer's disease Special Care Units (SCUs) for residents, family caregivers and facility staff. The cognitive, functional and behavioral deterioration of Alzheimer's disease patients almost inevitably culminates in the need for institutionalization, often extending for a period of several years, and costing society billions of dollars. In recent years there has been a proliferation of skilled nursing facilities claiming to provide 'specialized"""""""" care to residents with Alzheimer's disease or related dementias. Little is known about the characteristics, services, patient outcomes, and costs of these facilities beyond case studies and descriptive reports. In that there is increasing pressure to develop national and state regulatory controls for these facilities, as well as create reimbursements differentials for facilities providing """"""""specialized"""""""" care for dementia patients, this study will evaluate the outcomes, effectiveness, and costs of providing care in these settings. The proposed research will employ a quasi-experimental research design with data collected on SCU residents and non SCU residents at pre- and post- admission (6 months to skilled nursing facilities. Data will be obtained on a minimum of: 1) 162 institutionalized Alzheimer's disease patients residing in SCUs and 2) 162 controls randomly selected from Alzheimer's disease patients institutionalized in non-SCUs. Each cohort will consist of residents from skilled nursing facilities located in California or North Carolina, who have been diagnosed as having moderate to severe Alzheimer's disease or a related dementia, and who are socio-economically, functionally and cognitively representative of the Alzheimer's disease population. Information will be obtained using data collection instruments developed from the researchers' previous work, and will include: demographics; facility characteristics; problem behaviors; physical an pharmacological restraints; health, functional, and cognitive status; caregiver stress and satisfaction; staff stress and satisfaction; and costs of medical, social service, and informal care. Data will be collected through facility staff and family caregiver questionnaires, direct observations of residents and facilities, and review of medical charts. We intend to examine: 1) whether the number or severity of problem behaviors of dementia patients decreases after admission to a SCU; 2) whether the use of physical restraints and pharmacological restraints decreases after admission to a SCU; 3) the extent to which health status, functional level, and cognitive status of SCU residents is maintained or stabilized; 4) the extent to which family caregiver stress and satisfaction is positively related to admission to a SCU; 5) the extent of staff stress and satisfaction is positively related to resident admission to a SCU; and 6) the cost-effectiveness of formal and informal care related to SCUs.
